Abstract
Statins are the first-line therapy in LDL-Cholesterol (LDL-C) reduction and its clinical use has contributed to significant prevention and treatment of atherosclerotic vascular disease. Yet, a significant proportion of patients remain at high risk. Recently, a number of new therapies have been developed to further lower LDL-C. These agents may provide clinical benefit on top of statin therapy in patients with high residual risk, severe hypercholesterolemia or as an alternative for patients who are intolerant to statins. We review four novel approaches based on the inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9), apolipoprotein-B100 (apoB), Cholesteryl ester transport protein (CETP) and microsomal triglyceride transfer protein (MTP). ApoB and MTP inhibitors (Mipomersen and Lomitapide) are indicated only for homozygous familial hypercholesterolemia patients. The results of ongoing trials with CETP and PCSK9 inhibitors may warrant a wider employment in different categories of patients at high risk for cardiovascular disease.
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Maurizio Averna, Angelo B. Cefalù, and Davide Noto have served as clinical investigators in several hypolipidemic drug trials for Aegerion Merck, Pfizer, Sanofi, and Astra Zeneca. MR Averna is a member of Aegerion Europe and Italy Advisory Boards. The authors have no other relevant affiliations and financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript apart from those disclosed.
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Noto, D., Cefalù, A.B. & Averna, M.R. Beyond Statins: New Lipid Lowering Strategies to Reduce Cardiovascular Risk. Curr Atheroscler Rep 16, 414 (2014). https://doi.org/10.1007/s11883-014-0414-4
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DOI: https://doi.org/10.1007/s11883-014-0414-4